Health Letter, November 2014
By Michael Carome, M.D.
If you’re not outraged,
you’re not paying attention!
Read what Public Citizen has to say about the biggest blunders and outrageous offenses in the world of public health, published monthly in Health Letter.
For public health agencies such as the Centers for Disease Control and Prevention (CDC), maintaining credibility is critically important. Why? Because effective communication with both the health care community and the public is one of the most important tools these agencies use to prevent and control diseases that threaten public health, particularly serious contagious infections. For example, the CDC and other public health agencies have relied on guidance to the public on safe-sex practices to prevent the spread of HIV infection. If public health agencies lack credibility, their messages will go unheeded.
Last month, the leader of the CDC provided a textbook lesson on how to quickly squander an agency’s credibility as his agency sought to respond to the threat posed by Ebola.
With the Ebola epidemic raging in West Africa this fall, there was little doubt among knowledgeable public health experts that eventually, someone with Ebola would show up unexpectedly at a hospital in the U.S. Recognizing that inevitability, CDC Director Dr. Tom Frieden took to the airwaves to reassure Americans that hospitals throughout the country were well prepared to treat Ebola-infected patients.
For example, on Oct. 2, Frieden confidently stated the following:
“Just to reiterate, essentially any hospital in the country can safely take care of Ebola. You don’t need a special hospital room to do it. You do need a private room with a private bathroom. And most importantly, you need rigorous, meticulous training and materials to make sure that care is done safely so that the caregivers aren’t at risk.”
However, just days after making this and similar statements, the CDC director was proven dead wrong: On Oct. 12, Nina Pham, a nurse at Texas Health Presbyterian Hospital in Dallas who helped care for a Liberian man named Thomas Eric Duncan — the very first person in the U.S. to be diagnosed with Ebola — was found to have contracted the deadly disease. Three days later, Amber Vinson, another nurse involved in the care of the same patient also was diagnosed with the infection. After the death of Mr. Duncan, more than 70 other health care workers were being monitored for signs of Ebola infection, with the expectation that others may have been infected.
These events made it obvious that, contrary to Frieden’s initial assurances, many hospitals were not prepared to safely manage Ebola patients. Staff at the Dallas hospital, and likely at many other hospitals, apparently had not had the “rigorous, meticulous training” necessary to safely manage Ebola patients. And the CDC’s initial guidelines to hospitals on the type of protective gear health care workers needed to use when caring for Ebola patients proved to be inadequate. In the wake of the two Texas hospital nurses’ contracting Ebola, the CDC scrambled to issue more rigorous guidelines.
The media frenzy around events in Dallas led many to believe that the danger of contracting Ebola in the U.S. is greater than it really is, stoking unfounded anxiety and hysteria among the public and some health care workers. Unfortunately, in its effort to counter the misperception about the danger posed by Ebola, the false assurances from the CDC only served to magnify that hysteria and sow confusion.
The CDC director no doubt has learned from this episode that it is much easier to lose credibility than to restore it.
 Centers for Disease Control and Prevention. Press briefing transcript – CDC telebriefing: CDC update on first Ebola case diagnosed in the United States. October 2, 2014. http://www.cdc.gov/media/releases/2014/t1002-ebola-in-us-update.html. Accessed October 17, 2014.
 Fernandez M. 2nd Ebola case in U.S. stokes fears of health care workers. The New York Times. October 12, 2014. http://nyti.ms/1D4Hqtb. Accessed October 17, 2014.
 Fernandez M, Healy J. With new Ebola case confirmed, U.S. vows vigilance. The New York Times. October 12, 2014. http://nyti.ms/1yCtc2S. Accessed October 17, 2014.
 Beck M, McKay B. CDC to issue new guidelines for health workers dealing with Ebola: Nurses’ group has urged the agency to adopt a single standard. October 17, 2014. The Wall Street Journal. http://online.wsj.com/articles/cdc-to-issue-new-guidelines-for-health-workers-dealing-with-ebola-1413593787. Accessed October 18, 2014.